Sun and Skin Warnings

Time to take skin care seriously in the sun 

This is the time for sun and skin warnings, flaky skin, and looking out for skin changes that could be malignant. The following case was conducted on the National Health Service, UK.

As the skin belongs to my white face the surface skin and redness are clear. I searched for a comparison for black skin, and there was nothing! Hispanic skin is shown more frequently but this does not account for dark pigmentation.

Podiatry is now stepping up to the mark and despite being a foot specialty we take an interest in the whole body.

A case history - sun and skin damage

solar keratosis on the face. Looks like flaky skin but this is skin damage due to UV light.

The lesion is red and raised and might be eczema. This was Actinic Solar Keratosis. So the question was should we be worried? The picture was taken on day 10.

There was minimal itch and no bleeding. One diagnosis could have suggested a melanoma. The skin was dry and crusting so this might suggest pre-cancer as in squamous cell carcinoma. 

So should anything be done? Well, yes, one should not allow these lesions to continue without an opinion. My diagnosis was actinic solar keratosis. I had had one before but without the crusty appearance and it was not raised. Putting creams such as steroids on is not a good idea, and scratching is best avoided.

I wanted a clinician with a dermatoscope (see below) to give me an opinion and to see what the local GP practice was able to offer. These were Covid times, and I was apprehensive about timely appointments given the poor press.

What is solar keratosis?

As usual, the NHS site is probably the best for basic information. This gets my five-star rating for information at a comprehensive level. Below you can find another British site offering more information. 

“Actinic keratoses can be variable in appearance, even one patch differing from another within a single individual. At first they can be hard to see, and are more easily felt, as they may be rough like sandpaper. They may grow to a centimetre or two in diameter. Some are skin coloured, others are pink or reddish brown. They occasionally develop a thick scaly, warty layer. The surrounding skin often looks sun-damaged – blotchy, freckled and wrinkled”. Br Assoc. of Dermatologists

Time to call the GP

Now I confess I was a bit unsure about this as my faith wavers when it comes to GPs. I am not the best patient. This was Friday and I was hitting the second week having developed this skin condition. 

The receptionist told me I needed a telephone consultation. He did not know anyone specifically who had a dermatoscope. I could have been speaking about a bar of chocolate for all he knew, but he tried to be helpful. He offered me a call back from a locum doctor on Monday. He did ask if it was urgent. I knew it wasn’t and told him so. And so on Monday, the call came through, and we had a good chat.

Locum

'No, I don’t have a dermatoscope, but I hope to get one and have the training.” He was honest, and the next part of the conversation was fine by me.“Can you send me a picture?” he asked. I replied - 'Yes, I can, but photos taken with smartphones are not the same as those taken with a proper medical camera and lighting.'

Dermatologist

I sent him the pictures that Monday. By the end of the day not only had the GP surgery confirmed that I had an appointment with the local hospital (30 miles away), but gave me the date and time. A call came through from the hospital on the same Monday. This was followed up by written confirmation. Apologies were made that it would take 14 days. I was not worried as this was not as serious as some lesions.

A dermatoscope is now an important tool is differentiation skin problems from cancers.

Out came the dermatoscope. A proclamation that it was indeed an actinic solar keratosis. This was followed up by,

'Do you want to use the Solaraze (prescription of voltarol gel 3%) which would take 3 months to clear? Or, would you like me to freeze it and it is done and dusted but will hurt a bit?'

I liked the honest, straightforward, no-nonsense. 'Yep, get on a freeze it!'

The total time? Seven minutes from walking in and returning to the car. Within the day, the skin blistered mildly. I used some Vaseline as advised, then just left it alone and washed it as normal. My face is nearly back to normal and trouble-free.

Blister following cryosurgery for solar keratosis.

The dermatoscope saves on the premature procedure called a biopsy and local anaesthetic. The cryosurgery I had was a freezing therapy that dropped the skin to some -40C. Yes, it stings, but this is minor, and a painkiller is not required.

Thanks for reading my case history, ‘Sun and Skin Warnings’ by David R. Tollafield

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